Kokusai Hoken Iryo (Journal of International Health)
Print ISSN : 0917-6543
Volume 24 , Issue 1
Showing 1-6 articles out of 6 articles from the selected issue
Original Article
  • Naomi SEKI
    2009 Volume 24 Issue 1 Pages 1-11
    Published: 2009
    Released: April 28, 2009
     Since the end of World War II, Japan has successfully implemented of a number of community participatory programs. A program of particular note was the community-based vector and nuisance control program, named “Better life without mosquitoes and flies”. This program was promoted by community organizations based on the concept of vector control being carried out by people within their own communities. Entomology consultants also played an important role, through monitoring and evaluation of the program. Local, middle and central government health authorities supported the activities and connected the each actor tightly.
     The key factors that contributed to the program's success were clear role-sharing and the setting of common goals by community organizations, academic groups and government authorities. It is also worth noting that, in the immediate post-war period, Japan already possessed the core capacity required for the implementation of community-based sanitation programs introduced by General Headquarter.
     Due to cultural and environmental differences, the program described may not be directly applicable to the ongoing challenges of vector control faced by developing countries today. However, there are still some useful lessons to be learned from the experiences in Japan.
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Review Article
  • Ikuma NOZAKI, Kazuhiro KAKIMOTO, Toru CHOSA, Yutaka ISHIDA
    2009 Volume 24 Issue 1 Pages 13-22
    Published: 2009
    Released: April 28, 2009
     In recent years, antiretroviral therapy (ART) has been significantly expanded in developing countries, while drug resistance to HIV caused by low adherence is becoming a grave concern. As a member of the international community, Japan is expected to expand its cooperation for supporting the expansion of ART. However, the evaluation of ART adherence remains a challenge since the definition and the methods of its measurement are not standardized. In this regard, the articles of studies on ART adherence are reviewed to investigate available methodologies that can be used for measurement.
     Articles were searched and extracted through Ovid Full Text database for the period between Jan. 2002 and Aug. 2006 by using keywords of “adherence” and “HIV”. Among 81 extracted original articles, 50 articles were selected based on the inventory and clear identification of the methodologies used to measure adherence.
     The studies were conducted in the US (28 articles: 56%), Canada (5 articles: 10%), UK (3 articles: 6%), Africa and South America (10 articles: 20%) and no articles were extracted from Asia. The mean sample size of the studies was 581.2 (range: 24-6288). Measurements of adherence that were used in the articles as follows; patient's self-report (31 articles: 62%), electric drug monitoring (14 articles: 28%), pharmacy's refill record (12 articles: 24%), pill-count (9 articles: 18%), laboratory testing (6 articles: 12%) and combination of these (14 articles: 28%). Of the 31 articles using patient's self-report, 25 articles asked for the participant's frequency of missed dose.
     Studies concerned with ART adherence have been mainly undertaken in industrialized countries, and it was found that inquiries on missed doses were the most frequently used method to measure ART adherence. We strongly suggest the development of more simplified methods for measuring ART adherence, especially for resource-limited settings.
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    2009 Volume 24 Issue 1 Pages 23-29
    Published: 2009
    Released: April 28, 2009
     Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages.
     Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions.
     Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.
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    2009 Volume 24 Issue 1 Pages 31-40
    Published: 2009
    Released: April 28, 2009
     Recently, foreign residents' difficulties using the Japanese medical system are being acknowledged. This study investigates the case of the medical intake forms, monshinhyo, that new patients at Japanese medical facilities must complete. Many patients, especially non-native ones, find them difficult.
     First, 6 foreign and 6 Japanese students (hereafter, FS and JS) at 4-year universities were interviewed regarding their understanding of monshinhyo taken from three different departments -obstetrical, surgical, and internal medicine - at a hospital in Kansai; then, a questionnaire was developed and given to 25 FS and 85 JS.
     Both FS and JS noted language problems. JS could pronounce medical terms better than FS but comprehended them only about as well as FS. Moreover, both FS and JS found the styles, layouts, and purposes of some questions unclear, and they sometimes had to guess the details of what monshinhyo requested. These included questions involving symptoms, divisions of medical departments, and semantic range of terms for blood relations. Also, medical practices/norms not found in the native country sometimes puzzled FS.
     Problems with monshinhyo arise from both the patients' side-Japanese as well as foreign-due to limited medical-related vocabulary/kanji and/or a lack of experience using Japanese medical services, and the monshinhyo themselves, due to their inclusion of unclear questions and ambiguous expressions. Probably, monshinhyo's authors' familiarity with medical terms and the Japanese medical system caused them to take for granted more knowledge than many patients actually have. To improve medical services, therefore, we suggest reexamining and reorganizing questions that already exist, introducing multiple choice and yes/no questions when possible, and providing furigana for kanji. Fundamentally, throughout the medical system, patients should be able to understand all the language they encounter. Clarifying the language, cultural assumptions, and purpose(s) of monshinhyo is a good starting point.
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